Dear <<First name>>,
The South West London Tier 1 Chronic Kidney Disease (CKD) Identification, Monitoring and Management Service Specification (2026/27) is part of the SW London Cardio-Renal-Metabolic (CRM) Model. Londonwide LMCs has been in negotiation with South West London ICB over payments for the Tier 1 Service Specification, in collaboration with Surrey and Sussex LMCs colleagues.
There are two parts to this; the preliminary work from October 2026 to March 2027, and then a more substantive specification from April 2027. The LMCs understand that reference to a future Tier 2 Service Specification has now been withdrawn.
Whilst the Tier 1 Service Specification has been altered during negotiations, from October to March, practices are currently being asked to:
- Run the agreed CKD case-finding searches.
- Review and validate the search results.
- Identify and appropriately code patients with CKD.
- Identify patients who are due or overdue for the required CKD monitoring.
- Support completion of the required monitoring and update patient records as appropriate.
- Undertake blood test (eGFR) and urine ACR for CKD population.
The LMCs recognise that there are no specific achievement targets in the preliminary Tier 1 specification. However, uncertainty remains regarding the information participating practices may be asked to provide to their federation to enable completion of the end-of-programme Provider Assurance Return, and this represents a further administrative task.
We are also concerned that, where the ICB chooses a delivery mechanism involving federations or another intermediary as “the contracted supplier”, any associated administration or management costs (that may under current arrangements be retained by that organisation) should be funded separately by the ICB and should not reduce the funding reaching the practices undertaking the work.
The LMCs wish to advise colleagues that no agreement was reached between ourselves and SWL ICB over the funding for this service. It is our view that the funding available is significantly lower than needed to reimburse for the resources required for practices to undertake this work. The LMCs calculated the cost of the required work at approximately £21.96 per relevant patient, compared with the ICB offer of approximately £4.77 per patient. Practices should therefore consider carefully whether the funding offered adequately reimburses the resources required before deciding whether to participate.
The LMCs are disappointed that the Tier 1 specification was issued at the original funding level without the LMCs being informed despite discussions remained ongoing. At the time we were working to understand the significant difference between the ICB’s proposed funding and the LMC’s calculated cost, and whether an acceptable compromise could be reached.
Unfortunately, current discussions over the future Tier 1 Service are also demonstrating a significant mismatch between what funding may be available and the LMCs' calculated cost to practices of undertaking the work needed. The service under discussion is anticipated to commence in April 2027. The LMCs also believe these services would be most appropriately commissioned directly from practices under Locally Commissioned Service (LCS) arrangements.
We hope this update provides colleagues with a useful background.
Best wishes,
South West London LMCs
